File No. STATE OF NORTH CAROLINA In The General Court Of Justice Superior Court Division Before The Clerk NOTE TO APPLICANTS: The decision to apply for summary administration rather than regular administration County may have significant legal ramifications. Applicants are advised to seek legal counsel. IN THE MATTER OF THE ESTATE OF: Name And Address Of Decedent APPLICATION FOR PROBATE AND PETITION FOR SUMMARY ADMINISTRATION Social Security No. County Of Domicile At Time Of Death Date Of Death Date Of Will And Codicil(s) If Any Date Of Marriage Place Of Marriage (If Different From County Of Domicile) G.S. 28A-28-1 et. seq. Name And Mailing Address Of Petitioner Place Of Death (If Different From County Of Domicile) Name And Address Of Executor Or Coexecutor Of Will (If Different From Petitioner) Telephone No. Legal Residence (County, State) Telephone No. File No. Name And Address Of Attorney Telephone No. I, the undersigned, apply for probate of the paper writing(s) purporting to be the decedent's Last Will and Testament and codicil(s), dated as shown above. (NOTE: Check one of the following:) The original will [and codicil(s)] is already on file in the office of the Clerk of Superior Court. The original will [and codicil(s)] is attached. A certified copy of the will [and codicil(s)] is attached. Upon admission of the will to probate, and upon the recording of a certified copy of said will in each county in which is located any real estate or portion of real estate wholly or partially owned by the decedent, which recording I do hereby certify, I further petition the Court for an Order Of Summary Administration of the above estate. In support of this Application and Petition, being first duly sworn or affirmed, I say that: 1. The decedent was domiciled in this county at the time of the decedent's death. 2. I am the surviving spouse of the decedent, and I am the sole devisee and sole heir of the decedent. There is no other devisee or heir under the will. 3. The will does not prohibit summary administration. All property passing under the will, if any, goes directly to me and is not in trust. No application or petition for appointment of a personal representative is pending or has been granted in this State. did did not own an interest in real estate, wholly or partially, at the time of the decedent's death. A 4. The decedent complete legal description, sufficient to specifically identify each tract of such real property is attached. 5. The decedent did did not own an interest in personal property at the time of the decedent's death. A complete description of the nature of the decedent's personal property, the location and probable value of said property, to the extent that these facts are known or can with reasonable diligence be ascertained, is on the reverse. (NOTE: See the instructions for Inventory on side two of AOC-E-201.) 6. To the extent of the property received by me under the will of the decedent, I assume all liabilities of the decedent that were not discharged by reason of death, and I assume liability for all taxes and valid claims against the decedent or the estate, as provided in G.S. 28A-28-6. 7. A copy of this Petition has been personally delivered or sent by first class mail by me to the last known address, as listed above, of any executor or coexecutor named by the will, other than me. NOTE TO CLERK: This Application and Petition requires a three step process. First, the admission of the will to probate; second, the issuance of certified copies of the probated will, which the petitioner must then file in each county in which any portion of the real estate is located; and third, processing the Petition For Summary Administration. For the convenience of the parties, the application and petition are collapsed on to one form. AOC-E-905M, Rev. 3/07 © 2007 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkflow.com INVENTORY (Give values and descriptions as of date of decedent's death. Continue on separate attachment if necessary.) PART I. Market Value 1. Accounts in sole name of decedent (List bank, etc., each account no. and balance.) $ 2. Joint accounts without right of survivorship (List bank, etc., each account no., balance and joint owners.) % Owned By Dec. % Owned By Dec. % Owned By Dec. % Owned By Dec. 3. Stocks and bonds in sole name of decedent or jointly owned % Owned By Dec. without right of survivorship................................................................. 4. Cash and undeposited checks on hand....................................................................................... 5. Household furnishings.................................................................................................................. 6. Farm products, livestock, equipment and tools........................................................................... 7. Vehicles........................................................................................................................................ 8. Interest in partnership or sole proprietor businesses.................................................................. 9. Insurance, Retirement Plan, I.R.A., etc., payable to Estate........................................................ 10. Notes, judgments, and other debts due decedent....................................................................... 11. Miscellaneous personal property................................................................................................. 12. Real estate willed to the Estate............................................................. $ 13. Estimated annual income of Estate............................................................................................. $ TOTAL PART I. PART II. PROPERTY WHICH CAN BE ADDED TO ESTATE IF NEEDED TO PAY CLAIMS 1. Joint accounts with right of survivorship (List bank, etc., each account no., balance & joint owners.) $ 2. Stocks and bonds jointly owned with right of survivorship......................................................... 3. Other personal property recoverable (G.S. 28A-15-10)............................................................. 4. Real estate owned by decedent and not listed elsewhere......................................................... 1. 2. 3. 4. $ TOTAL PART II. PART III. Entireties Real Estate owned by decedent and spouse (List 1/2 value).......................................... $ Insurance, Retirement Plan, I.R.A., accounts, etc., payable to named beneficiaries................. are are not transfers over which decedent retained any interest as There described in N.C. Inheritance Tax Laws, G.S. 105-2(3) through 105-2(6)................................. were were not gifts made 3 years or less before decedent's death.................... There $ TOTAL PART III. Date SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Of Applicant Signature Deputy CSC Assistant CSC Clerk Of Superior Court Name Of Applicant (Type Or Print) Date My Commission Expires Notary County Where Notarized SEAL AOC-E-905M, Side Two, Rev. 3/07 © 2007 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com